Project Summary/Abstract South Africa has the greatest burden of HIV infection in the world, and South African adolescent girls and young women (SA-AGYW) ages 15-24 are at greatest risk. Mental health distress (anxiety, trauma, depression) and intimate partner violence (IPV) are implicated as drivers of HIV, yet few studies have assessed the combined effects of mental health and IPV on SA-AGYW sexual risk behavior (early sexual debut, no condom use at last sex, multiple sexual partners). Notably, high warmth and frequent communication about sexual topics between female caregivers and AGYW are associated with reduced AGYW sexual risk behavior, but few studies have examined the impact of female caregiver-AGYW communication and warmth in the presence of mental health distress and IPV on AGYW sexual risk taking. The proposed fellowship will provide much needed training to prepare me for a career as a physician scientist with a global health program of research. Guided by an expert mentorship team to oversee my training activities, I will gain skills in adolescent and young adult mental health distress, sexual risk behaviors, and their roles as drivers of HIV infection, HIV epidemiology, advanced qualitative research, and complete my medical and PhD degrees. I will use these new skills to carry out a mixed methods research study integrating quantitative and qualitative methods to accomplish two specific aims. In Aim 1, I will conduct secondary analyses of baseline data from a large HIV prevention intervention involving SA-AGYW and their female caregivers (IMARA-SA). Analyses of 642 AGYW will examine mental health distress, IPV, and AGYW-caregiver warmth and communication as drivers of AGYW sexually transmitted infections, including HIV. Preliminary data from the parent study revealed high rates mental health distress and IPV. I hypothesize that increased warmth and communication between AGYW and female caregivers will decrease the association between mental health distress and sexual risk behaviors even in the presence of IPV. In Aim 2, I will supplement the quantitative analysis with 20- 30 qualitative interviews with SA-AGYW with experiences of IPV. I will purposively select participants from the parent study who have completed the 12-month follow up and reported IPV. Interviews will offer new insight into the impact of female caregiver communication about addressing experiences of IPV and sexual risk behavior. The findings from aims 1 and 2 will inform interventions to improve the SA-AGYW mental health, lessen IPV exposure, and strengthen sexual and reproductive health. Mentorship provided by an experienced team with a long history of collaboration will ensure excellent training, extensive opportunities to publish in high impact journals and present at international scientific conferences, and exposure to colleagues through networking. This F30 fellowship will provide a well-rounded education that empowers me to become a physician-scientist with a ...